Period: Sep 2024 - may 2025

Aim: The purpose of this quality improvement study is to investigate whether the use of ultrasound by surgeons at AUH during bladder cancer surgeries meets the required standard for identifying suspicious lymph nodes and, in the long term, to assist and optimize the template for lymph node removal.

Method: This prospective quality improvement study will take place on Aarhus University Hospital and we will recruit approx. 20 patients. Ultrasound will be used intraoperatively and descriptions of each ultrasound positive lymph node will be entered in a secure database in REDCap. The primary endpoint is the feasibility of the ultrasound probe. This is assessed by comparing our ultrasound findings with the pathological results, after which we calculate sensitivity and specificity, which we hope will meet the necessary standards for identifying suspicious lymph nodes.

Background: Pelvic lymph node dissection (PLND) during radical cystectomy is an important part in the staging of muscle invasive bladder cancer. However, this procedure is extensive both in terms of time and quantity, as the template for how many lymph nodes need to be removed is large. It thus involves the removal of many healthy lymph nodes, as only 13.5% have pathological (diseased) lymph nodes upon subsequent pathological examination of the tissue from the operation. A tool to optimize lymph node dissection would benefit patients, surgeons, and hospitals by potentially reducing surgery time and improving overall efficiency. It is time to optimize the PNLD?

Inclusion: Bladder cancer patients treated with robot-assisted cystectomy at Aarhus University Hospital. Hopefully recruitment start in October 2024.